Shoulder Replacement Consent

Overall it carries a low risk of complication, but as with any operation this must be considered prior to the surgery. For this procedure the risks are:

Common Complications (risk between 1 in 100 and 5 in 100):

Skin wound infection: this is an easily treated infection of the skin around the wounds. It settles with antibiotics and has no longlasting effect on the outcome of surgery. If wounds become red or ooze, then medical attention is needed to asses whether antibiotics are required.

Persistent symptoms: occasionally patients will continue to have shoulder pain and stiffness after the operation, despite technically successful surgery.

Dislocations: If you undergo a reverse shoulder shoulder replacement, the shoulder may dislocate after the procedure. This usually occurs within the first 6 weeks following surgery, but may occur at any time. This usually requires further surgery to corect the problem.

Arm length discrepancy: If you undergo a reverse shoulder shoulder replacement, the upper arm is elongated by a centimetre or two and your shoulder width is narrowed. This does not usually cause a functional problem, but can sometimes be noticed.

Altered appearance of the biceps and chest wall muscle (Pectoralis major): The tendons for both of these muscles are cut during the operation in order to obtain access to the joint. Although these are repaired at the end of the procedure, occasionally their external appearance may be altered. This does not ususally affect the function of the shoulder.

Infrequent Complcations (risk between 1 in 100 and 1 in 10,000):

Deep joint infection: this is an infection below the skin within the shoulder joint. This usually requires further surgery to eliminate the infection.

Nerve injury: this is a rare complication that can result in altered sensation, pain or weakness in the arm. If it does occur it is usually temporary and resolves over several months. Extremely rarely it can be permanent.

Fractures: It is possible for the some part of the bones to be broken during the operation. Usually this is seen during the operation and can be dealt with immediately. Sometimes it is found after the opeartion and may require further surgery.

Extremely Rare Complications (risk of less than 1 in 10,000)

Blood clots: this is extremely rare with shoulder surgery, but can result in a deep vein thrombosis within the calf or a clot within the lungs, known as a pulmonary embolism. To reduce these risks you will be assessed prior to the operation and may require compression calf stockings, calf pumps or blood thinning injections. We encourage early mobilistion after the operation, as this is the best way to reduce this risk.

Anaesthetic Risks

This operation is performed under a general anesthetic and a regional anaesthetic nerve block. The anaesthetist will see you in the morning of the operation and explain about both procedures to you. If you have chronic medical conditions certain risks may be higher and this will be discussed with you at the consultation prior to a decision being made about proceeding to an operation.

Common temporary side effects (risk between 1 in 100 to 10 in 100): occasionally you may suffer from bruising or pain at the site of injections, blurred vision and sickness. This can all be treated easily and tend to subside quickly. The nerve block will cause pins and needles in your arm and hand when it is wearing off. It can also temporarily cause drooping of your eyelid (but does not affect your vision), flushing of your face, hoarseness of the voice and a feeling of not being able to take a deep breath.

Infrequent complications (risk between 1 in 100 to 1 in 10,000): occasionally the pins and needles or weakness in the arm can last weeks or months, but longterm problems are very rare. Temporary breathing and speech problems, damage to teeth or lip or tongue, sore throat, muscles pains and headaches.

Extremely rare complications (risk of less than 1 in 10,000): severe allergic reaction, permanent damage to the kidney, liver, lung, eye, brain voice box, nerves or blood vessels. All of which are extremely rare, but would require further intervention and potentially could be a risk to life.

Predictable Long Term Consequences:

Both types of shoulder replacement are expected to function well for about ten years and often there are no problems for much longer than this. Ultimately however, the shoulder components may become loose or wear out. In a standard shoulder replacement the tendons may wear out. In a reverse shoulder replacement the strength of the deltoid muscle (outer muscle of your shoulder) may deteriorate with time and gradually reduce the function of the shoulder replacement. All of these problems may result in reduced pain and function and suggest a review by the shoulder surgeon is appropriate. It may be possible to perform a revision operation, which can be discussed in more detail.

Again it must be reiterated that overall this is a low risk procedure, but if you have concerns please raise these with the surgeon or anaesthetist to discuss them further.